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Related Experiment Videos

Intracranial pressure changes during bilateral radical neck dissections

K L Weiss1, M K Wax, R C Haydon

  • 1Carolina ENT, Gastonia, North Carolina.

Head & Neck
|November 1, 1993
PubMed
Summary

Bilateral radical neck dissection (RND) can cause significant intracranial pressure (ICP) spikes, especially after sacrificing both internal jugular veins (IJVs). Monitoring and intervention are crucial for patient safety during staged procedures.

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Area of Science:

  • Neurosurgery
  • Oncology

Background:

  • Management of the contralateral neck after radical neck dissection (RND) for head and neck cancer is debated.
  • Some patients require a second RND, potentially involving sacrifice of both internal jugular veins (IJVs).

Observation:

  • Four patients undergoing staged bilateral RNDs had intracranial pressure (ICP) monitored via subarachnoid bolt.
  • Simultaneous monitoring of jugular bulb, arterial, pulmonary artery, and central venous pressures, along with electroencephalography (EEG), was performed.
  • ICP elevations occurred upon head rotation and marked increases followed IJV ligation.

Findings:

  • Three of four patients experienced ICP levels exceeding 40 mm Hg post-IJV ligation.
  • Systemic hypertension (Cushing's reflex) was observed in response to elevated ICP.

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  • Despite significant ICP rises, all patients recovered without major sequelae, with ICP normalizing within 24 hours.

    • Implications:

    • Staged bilateral RNDs necessitate anticipation, monitoring, and treatment of significant ICP increases.
    • Intraoperative intervention was required in three patients to manage elevated ICP.
    • Sacrificing the second IJV during RND requires proactive management of potential ICP complications.